Spring pollen hurts more than just people with allergies; it also harms asthma patients.

Besides seasonal allergies, smoking and air pollution also play a role in whether someone develops asthma and how severe that asthma is likely to be. (Allergies are a huge factor, according to the Asthma and Allergy Foundation of America; 60 percent of people with asthma also have allergies.)

Health care access and poverty are other indicators of how prevalent asthma is likely to be in a region, as well as how well residents are able to control their condition.

Raising awareness for poor asthma areas might help improve treatment, AAFA spokesperson Talisia White said in a press release. “There are many things that we can improve now to make life better for people with asthma,” White said. “Some patients have a hard time avoiding their triggers, others just don’t take daily medications like they should or they don’t have access to proper asthma care and education. Our Asthma Capitals report helps to shed light on the asthma burden in each city, but it also provides a roadmap for improvements.”

Nationwide, nearly 25 million people have asthma. Every day, an average of nine people die from complications of the condition. Many people with self-reported moderate asthma might actually have a severe form of the disease, potentially causing them to miss important warnings and clues about their asthma, the AAFA said after a nationwide survey. Nearly half of those surveyed who did not initially report severe asthma, reported symptoms or measures that are indicators of possibly severe asthma, the organization said in a press release, indicating that more information on asthma triggers and symptoms is needed.

Is your home city a poor place for asthma? Click through the slideshow above to find out.